title: Internal hernia after laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  The goal of this study was to determine the impact of mesenteric defect closure and Roux limb position on the rate of internal hernia after laparoscopic Roux-en-Y gastric bypass (LRYGB).
  
  
  METHODS
  A retrospective review was conducted of all LRYGB patients from 2001 to 2011 who had all internal hernia (IH) defects closed (DC) or all defects not closed (DnC).
  
  
  RESULTS
  Of 914 patients, 663 (72.5 %) had DC vs. 251 (27.5 %) with DnC, and 679 (74.3 %) had an ante-colic vs. 235 (25.7 %) with a retro-colic Roux limb. Forty-six patients (5 %) developed a symptomatic IH. Of these, 25 (3.8 %) were in the DC vs. 21 (8.4 %) in the DnC group (p = 0.005), and 26 (3.8 %) were in the ante-colic vs. 20 (8.5 %) in the retro-colic Roux limb position (p = 0.005). Data from 45 patients were available for further analysis. The most common symptom was chronic postprandial abdominal pain (53.4 %). All patients underwent CT scan consistent with IH in 26 patients (57.5 %), suggestive in 7 (15.6 %), showing small bowel obstruction in 4 (8.9 %), and negative in 8 (17.8 %).
  
  
  CONCLUSIONS
  Closure of mesenteric defects and ante-colic Roux limb position result in a significantly lower IH rate. Furthermore, a high index of suspicion must be maintained since symptoms may be nonspecific and imaging may be negative in nearly 20 % of patients.
authors.affiliation: Department of Surgery, University of Alabama at Birmingham, KB401, 1720 2nd Ave S, Birmingham, AL, 35294-0016, USA.
authors.forename: Ayman
authors.initials: A
authors.lastname: Obeid
authors.forename: Sandre
authors.initials: S
authors.lastname: McNeal
authors.forename: Matthew
authors.initials: M
authors.lastname: Breland
authors.forename: Richard
authors.initials: R
authors.lastname: Stahl
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Clements
authors.forename: Jayleen
authors.initials: J
authors.lastname: Grams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006547:Hernia / Q000000981:diagnostic imaging / Q000209:etiology*; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008643:Mesentery / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D058106:Wound Closure Techniques; D055815:Young Adult